BLUNT DIAPHRAGMATIC AND THORACIC AORTIC RUPTURE - AN EMERGING INJURY COMPLEX

Although both blunt diaphragmatic rupture (BDR) and thoracic aortic ru pture (TAR) have been extensively discussed, the association of both i njuries has been infrequently mentioned. The purpose of this study was to examine the current prevalence and clinical characteristics of com bined BDR and TAR at an adult regional trauma unit. Among 3,886 trauma victims, 69 (1.8%) had a BDR and 44 (1.1%), a TAR. Seven patients (10 % of all patients with a BDR) had both injuries. All 7 were victims of motor vehicle crashes and had a mean Injury Severity Score of 35. All TARs were just distal to the origin of the left subclavian artery. Fi ve patients underwent repair of both injuries and survived, 1 patient had only the BDR repaired and survived, and 1 died during emergency th oracotomy, for a survival rate of 86%. Five patients had laparotomy an d repair of the BDR in the presence of an unrepaired TAR. The TARs wer e repaired by the clamp-and-sew technique, three of them with primary repair and two with interposition tube grafts. Concomitant BDR and TAR appears to be an emerging injury complex with both diagnostic and the rapeutic challenges. The presence of BDR demands a rigorous search for associated TAR.